A woman complained about the care provided to her 54-year-old
husband, who was admitted to a relatively small rural hospital for
overnight observation following an episode of severe chest pain.
The patient was admitted in accordance with the hospital chest pain
protocol. He received examination and review, ECG testing, and
classic cardiac enzyme testing. The patient's test results also
included two normal troponin T "spot" tests, which are taken by the
bedside with results available in 15 minutes, and a negative
troponin I laboratory test, the results of which are not available
immediately as they are sent to a main centre for analysis. The
investigations were regarded as normal and the patient was
discharged with a diagnosis of gastro-oesophageal reflux disease,
without being informed that he had one troponin I blood test
outstanding.

The medical officer was informed of an elevated result later
that evening but decided that it was not particularly significant.
The following morning the patient's file was reviewed by another
doctor, who considered that there were indications of ischaemic
heart disease, in particular subtle ECG changes and the elevated
troponin I test result. The medical officer was notified and he
agreed to urgently notify the patient's general practitioner to
arrange immediate follow-up. The medical officer contacted the
general practitioner around midday. The general practitioner's
practice nurse left a message for the patient at his home later
that afternoon, without conveying any urgency. In the early hours
of the following morning, the patient suffered further chest pain,
and died.

It was held that due to the subtlety of the ECG changes, the
medical officer could not reasonably have been expected to reach a
diagnosis of ischaemic heart disease, nor could he have predicted
the patient's subsequent death. However, the patient should not
have been discharged to general practitioner care without seeking
cardiology input. This constituted a breach of Right 4(1). The
doctor did not provide the general practitioner with appropriate
information about the urgency of the follow-up, a breach of Right
4(5). In addition, the patient was not provided with appropriate
information about his condition at the time of his discharge,
breaching Right 6(1)(a), and the doctor's medical records were
considered inadequate, a breach of Right 4(2).

The hospital was not held liable for an apparent lack of
education and support provided to the medical officer.

This case reinforces the importance of medical officers
obtaining advice from senior doctors before making significant
clinical decisions, and shows the importance of small rural
hospitals providing appropriate education, support and resources
for staff.